Severe fetal thrombocytopenia in Rhesus D alloimmunized pregnancies.
OBJECTIVE
The objective of the study was to evaluate the incidence of fetal thrombocytopenia and association with hydrops in Rhesus D alloimmunization.


METHODS
The study was a retrospective chart review of 914 intrauterine transfusions in 314 pregnancies performed between 1988 and 2005 in a single institution. The incidence of thrombocytopenia and severity of hydrops at cordocentesis were assessed and correlated with perinatal mortality.


RESULTS
Thrombocytopenia (less than 150 x 10(9)/L) was found in 241 of 914 (26%) and severe thrombocytopenia (less than 50 x 10(9)/L) in 25 of 914 (3%) cordocentesis. Twenty-three percent of severely hydropic fetuses had severe thrombocytopenia, compared with 3% and 1% of mildly hydropic and nonhydropic fetuses, respectively. Thrombocytopenia was an independent risk factor for perinatal mortality. Mortality in fetuses that were severely thrombocytopenic and severely hydropic was 67%.


CONCLUSIONS
Thrombocytopenia is common in hydropic anemic fetuses. Severe thrombocytopenia is associated with a poor prognosis, irrespective of the presence of hydrops. The option of platelet transfusion in severely hydropic anemic fetuses needs further study.
van den Akker
Eline S A
ES
Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands. e.s.a.van_den_akker@lumc.nl
de Haan
Timo R
TR
Lopriore
Enrico
E
Brand
Anneke
A
Kanhai
Humphrey H H
HH
Oepkes
Dick
D
D000328:Adult; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000276:immunology; D005315:Fetal Diseases / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D015160:Hydrops Fetalis / Q000453:epidemiology*; D015994:Incidence; D010976:Platelet Count; D011247:Pregnancy; D011379:Prognosis; D012203:Rh Isoimmunization / Q000150:complications*; D013921:Thrombocytopenia / Q000453:epidemiology* / Q000276:immunology*